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The use of anabolic-androgenic steroids (AAS) for reasons other than medical treatment, was considered to be restricted to the bodybuilders or professional athletes. A study in 2001, by our research unit, demonstrated a high prevalence of AAS use by recreational gym users. From 106 questionnaires, 53% (56/106) had used AAS within the past year but no females reported using AAS.

The present study was conducted amongst a similar sample of recreational gym users in the South Wales area.

From 146 questionnaires, 70% (102/146 individuals) reported AAS use and 7% (10/146 individuals) of respondents were female. Mean age of sample was 33.6 ± 6.7 years and ranged from 15-72 years of age. This research demonstrated an enormous increase in the drug, growth hormone (24%), which had been used to reduce body fat.

The demographic and social characteristics of the respondents indicated that AAS users were from differing socioeconomic backgrounds (wealthy and non-wealthy) and did not fall into any specific category (working class, middle class or upper class).

In the recreational fitness industry their use would appear to be predominantly for vanity and cosmetic reasons.

INTRODUCTION

The use of anabolic androgenic steroids (AAS) affects numerous risk factors associated with the development of cardiovascular disease (CVD) [1]. There are also cases of sudden death associated with their use [2]. Anabolic steroids are a powerful group of natural or synthetic compounds similar in chemical structure to the natural male steroid hormone testosterone. Synthetic steroids differ from the natural androgenic steroid testosterone by alterations in basic structure. These alterations include the addition of methyl, hydroxyl, ethyl or benzoyl at one or more sites along the synthetic steroid structure. The balance between androgenic functions and anabolic functions differ in each steroid hormone, and there is no anabolic-androgenic steroid that affects an athlete anabolically without an androgenic affect [3]. The principal physiological action of anabolic steroids is the stimulation of a protein anabolic or constructive phase of metabolism in the body and they have been demonstrated to increase muscle mass and strength [4].

There is little research to date on recreational gym users in the UK. Much of the iterature related to AAS use comes from studies conducted in the U.S. [5]. Evidence from the U.S. also indicates that AAS is not confined to the competitive athlete and AAS users can be found among health, and fitness enthusiasts and collegiate and high-school students It was estimated that in the mid 1980’s, approximately one million Americans were using AAS for physique enhancement [6]. No epidemiological study to date has demonstrated a decrease in AAS consumption.

The first nation-wide AAS survey in the UK [7] surveyed 21 gyms throughout Britain and found that 8% of respondents admitted having taken AAS at some time, 5% of which were current users (9.1% of men and 2.3% of women). There was considerable variability between gyms, ranging from no use in one gym to 46% in another. A survey of 100 athletes using AAS, in three South Wales counties [8], reported high rates of Polypharmacy (80%) with a wide array of drugs amongst their sample group. The purpose of this study was to assess the use of AAS among recreational gym users in the South Wales area.

METHODS

Ethical approval for this study was granted by the Bro Taf Health Authority. The three gymnasiums included in this survey were researched from the AAS using subjects who were on the database at the University’s research unit. The gyms were predominantly used by males. The clients using the gymnasium training facilities were offered a previously validated questionnaire [7] by a member of the university research team and were assured of anonymity. As this survey concentrated on so called ‘hardcore’ gymnasiums, the sample contains an obvious bias. This survey does however; attempt to ascertain the prevalence of AAS use in these establishments. Anabolic Androgenic Steroid (AAS) Abuse The Open Sports Medicine Journal, 2008, Volume 2 39

RESULTS

One hundred forty six survey's were completed. Of the respondents, 70% (102/146) had used AAS within the previous year and 65.8% (96) were currently using. 7% (10/146) of respondents were female. The demographic and social characteristics of the respondents indicated that AAS users were from differing socioeconomic backgrounds. 85% of the AAS users were in full time employment (including manual workers, clerical workers and employees from different professional backgrounds) and 15% were unemployed. 96% of individuals reported that they encountered no problem in obtaining the AAS of their choice. AAS use generally began in the late teen years (mean ± SD; 18 ± 4.1 years), and users were predominantly introduced by friends and training colleagues. Polypharmacy was evident amongst both samples. Table 1 demonstrates the results from 2001 and Table 2 demonstrates the results from the present study.

Table 1. Shows Drugs other than AAS Reported by the AAS Using Respondents in 2001 (n=56) [9]

Type of Drug

% Use

Ephedrine

42

Clenbuterol

18

Human Chorionic Gonadatrophin

15

Tamoxifen

12

Insulin

8

Growth Hormone

6

Thyroid Hormone

4

Diuretics

4

Table 2. Current Drugs Other Than AAS Reported by AAS Using Respondents (n=96)

Type of Drug

% Use

Ephedrine

44

Clenbuterol

21

Human Chorionic Gonadatrophin

11

Tamoxifen

22

Insulin

14

Growth Hormone

24

Thyroid Hormone

10

Diuretics

10

DISCUSSION

The prevalence of AAS use in this study is the highest reported in any study to date in the U.K. with 70% of respondents being regular AAS users. The incidence of AAS use observed is considerably higher than the previous Welsh report of 58% [9].

The youngest respondent was 15 and the oldest was 72 years of age. The prevalence of AAS use amongst minors in South Wales is currently unknown. The majority of users in the present study began AAS administration at an early age. AAS use amongst adolescents is especially dangerous because of the added physiological side effect of early epiphyseal closure, resulting in reduced final adult height.

In the U.S., concern for the use of AAS amongst adolescents has led to the implementation of educational programmes aimed at educating young Americans about the dangers of using these drugs. Recent evaluation of such an intervention [10], have proven positive. Based on the findings of the present study, a U.K. based educational programme would seem warranted. In addition, physicians and medical personnel must be aware that AAS use is not only confined to sports persons, but is evident amongst all areas of society, and members of society must be informed and aware of the variety of negative health effects associated with their use.